23. Does the maximum allowable contrast dose (MACD) predict the risk of contrast induced nephropathy (CIN) in patients with chronic kidney disease (CKD)

BackgroundCIN is associated with high in-hospital mortality. Some studies recommend the utilization of the MACD formula to guide safe contrast dosing, however the evidence supporting use of this measure is limited.ObjectiveThe purpose of this study was to determine if MACD is helpful in predicting the risk of CIN in patients with CKD.Methods8670 patients who underwent coronary angiography in our center with or without Percutaneous Coronary Intervention (PCI) (2008–2013) were included. Patients with CKD (n=144) were selected. Patients in shock, on intra aortic balloon pump, on prophylactic hemofiltration or on dialysis were excluded.Creatinine was measured 48–72h post procedure. T-test, Chi-Square and multiple regression were used to compare those patients who developed CIN and those who did not develop CIN. CIN was defined as an increase in serum creatinine by ⩾25% or 0.5mg/dL from baseline within 48–72h after contrast exposure.ResultsCIN occurred in 28 patients (19.4%). Only 8 (5.6%) of the 144 patients exceeded MACD and 2 of these patients developed CIN. The use of biplane angiography explains the lower contrast dose. For this reason the impact of exceeding MACD could not be evaluated. Primary PCI was associated with CIN (p=0.012; OR 5.1)).ConclusionOverall it is best to limit contrast dose to the extent possible as this is a known risk factor, however MACD is not a useful variable in a risk model for predicting CIN in our population. Primary PCI was the only predictor of CIN in our population

Catalytic effectiveness of azobisisobutyronitrile/[SiMes)Ru(PPH3)(Ind)Cl2 initiating system in the polymerization of methyl methacrylate and other vinylic monomers

The catalytic system of azo-bis-isobutyronitrile (AIBN) combined with (SiMes)Ru(PPH3)(Ind)Cl-2 [M-20] was investigated for the controlled radical polymerization of methyl methacrylate (MMA) in solution. Various factors that may influence the catalytic polymerization process, such as the aging time of the initiating system, AIBN/M-20 ratio, concentration of monomer, polymerization time, temperature, and the nature of solvent were examined. The results showed that the yield, molecular weight, and molecular distribution are practically unaffected by these parameters; however, the syndiotactic stereo-structure tendency that characterizes the produced poly(methyl methacrylate) (PMMA) varied with temperature. The optimum conditions for PMMA synthesis were determined to produce an essentially syndiotactic material with uniformly high molecular weights. It was also revealed that the kinetics of MMA polymerization is of first order with respect to the concentration of monomer. A comparison was also made for some vinylic polymers synthesized either with the AIBN alone or with the AIBN/M-20 initiating system under the same conditions

Role of Interventional Radiology in Management of Gastrointestinal Bleeding

Gastrointestinal bleeding is a common and potentially life-threatening condition that requires prompt and effective management. Interventional radiology has emerged as a valuable tool in the management of gastrointestinal bleeding, offering minimally invasive techniques that can rapidly control bleeding and improve patient outcomes. This review aims to provide an overview of the role of interventional radiology in the management of gastrointestinal bleeding, including its various techniques and their efficacy. The review discusses the different interventional radiology procedures that can be used to diagnose and treat gastrointestinal bleeding. It also highlights the advantages of techniques used in evaluation and management, including their ability to localize and control bleeding, as well as their low complication rates and shorter recovery times compared to traditional surgical approaches. Furthermore, the review addresses the specific indications for interventional radiology in the management of gastrointestinal bleeding, as well as the role of interventional radiology in the setting of underlying conditions. Overall, this review provides a comprehensive overview of the role of interventional radiology in the management of gastrointestinal bleeding, highlighting its effectiveness and potential benefits for patients. It also emphasizes the need for further research and collaboration between interventional radiologists and gastroenterologists to optimize the use of these techniques in clinical practice

Production of green diesel from catalytic deoxygenation of chicken fat oil over a series binary metal oxide-supported MWCNTs

Deoxygenation processes that exploit milder reaction conditions under H2-free atmospheres appear environmentally and economically effective for the production of green diesel. Herein, green diesel was produced by catalytic deoxygenation of chicken fat oil (CFO) over oxides of binary metal pairs (Ni–Mg, Ni–Mn, Ni–Cu, Ni–Ce) supported on multi-walled carbon nanotubes (MWCNTs). The presence of Mg and Mn with Ni afforded greater deoxygenation activity, with hydrocarbon yields of >75% and n-(C15 + C17) selectivity of >81%, indicating that decarboxylation/decarbonylation (deCOx) of CFO is favoured by the existence of high amount of lower strength strong acidic sites along with noticeable strongly basic sites. Based on a series of studies of different Mg and Mn dosages (5–20 wt%), the oxygen free-rich diesel-range hydrocarbons produced efficiently by Ni10–Mg15/MWCNT and Ni10–Mn5/MWCNT catalysts yielded >84% of hydrocarbons, with n-(C15 + C17) selectivity of >85%. The heating value of the green diesel obtained complied with the ultra-low sulphur diesel standard

Production of renewable diesel from Jatropha curcas oil via pyrolytic-deoxygenation over various multi-wall carbon nanotube-based catalysts

Jatropha curcas is a highly toxic plant that produces seed containing viscous oil with productivity (2 ton/ha), it grows in tropical and sub-tropical regions and offer greater adaptability to a wide range of climatic and soil conditions. Its oils have been noted as an important alternative to produce green diesel via deoxygenation reaction. This study, deoxygenation of jatropha curcas oil (JCO) was carried out over NiO–Fe2O3 and NiO–ZnO catalysts that supported onto multi-walled carbon nanotube (MWCNT). It had found that high Fe and Zn dosages were ineffective in deoxygenation and greatest activity was observed on NiO(20) Fe2O3(5)/MWCNT catalyst. Structure-activity correlations revealed that low metal loading, large density of weak + medium acidic sites and strong basic sites play key role in enhancing the catalytic activities and n-(C15+C17) selectivity. Comparing carbon nanostructures and carbon micron size supported NiO-Fe2O3 revealed that green diesel obtained from NiO–Fe2O3/MWCNT catalysed deoxygenation had the highest heating value and the lowest amounts of oxygen content. Thereby, it confirmed the importance of carbon nanostructure as the catalyst support in improving the diesel quality. Considering the high reusability of NiO-Fe2O3/MWCNT (6 consecutive runs) and superior green diesel properties (flash point, cloud properties and cetane index) demonstrated the NiO–Fe2O3/MWCNT catalyst offers great option in producing excellent properties of green diesel for energy sector

A promoter effect on hydrodeoxygenation reactions of oleic acid by zeolite beta catalysts

In this study, various metal-modified zeolite beta-based catalysts such as La(10)zeo(90), Co(10)zeo(90), Fe(10)zeo(90), Mg(10)zeo(90), Mn(10)zeo(90) and Zn(10)zeo(90) were investigated in the hydrodeoxygenation (HDO) of oleic acid (OA) to produce renewable diesel. The La(10)zeo(90) catalyst showed a conversion of OA up to 99 % with 83 % C15 and C17 selectivity after the reaction at 350 ◦C for 2 h under 4 MPa H2 pressure. The superior activity of La(10)zeo(90) was attributed to the synergistic interaction between La-Si-Al, a sufficient amount of weak+ medium acid sites and excellent textural properties (large pore diameter). Larger pore diameter of La(10)zeo(90) is highly desirable as it will generate greater diffusion of bulky molecules, thereby improving the accessibility of the reactant and hence excellent catalytic activity. The vacuum distillation was used to purify the crude liquid product (CLP), producing high-quality diesel fractions mainly comprising C14, C15, and C17 fractions

Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals

(1) Background: Inappropriate use of antimicrobials and subsequently rise of antimicrobial resistance (AMR) remains a major public health priority. Over-prescribing of broad-spectrum antibiotics is one of the main contributing factors for the emergence of AMR. We sought to describe antimicrobial prescribing trends among patients in public hospitals in Makkah hospitals. (2) Method: We undertook a point prevalence survey (PPS) in six hospitals in Makkah, Saudi Arabia, from January 2019 to July 2019. The survey included all the inpatients receiving antimicrobials on the day of PPS. Data was collected using the Global point prevalence survey (PPS) tool developed by the University of Antwerp, Belgium. (3) Results: Of 710 hospitalized patients, 447 patients (61.9%) were treated with one or more antimicrobials during the study period. The average bed occupancy among six hospitals was 74.4%. The majority of patients received antimicrobials parenterally (90.3%). Of the total prescribed antimicrobials, 415 (53.7%) antimicrobials were used in medical departments, 183 (23.7%) in surgical departments, and 175 (22.6%) in ICUs. Pneumonia (17.3%), skin and soft tissue infections (10.9%), and sepsis (6.6.%) were three common clinical indications. Ceftriaxones were the most commonly used antibiotics that were prescribed in 116 (15%) of patients, followed by piperacillin, with an enzyme inhibitor in 84 (10.9%). (4) Conclusion: There was a high prevalence of antibiotic use in the hospitals of Makkah, which could be a potential risk factor for the incidence of resistant strains, particularly MRSA infection. Public health decision-makers should take these findings into consideration to update national policies for antibiotic use in order to reduce the risks of further increases of AMR

Oral semaglutide adequate glycaemia control with safe cardiovascular ‎profile

BackgroundType 2 diabetes is a chronic and progressive disease that ‎associated with series complication such as major adverse ‎cardiovascular events. Adequate glycaemic control proven ‎to reduce this risk. Orally administered semaglutide ‎promising medication in managing patient with type 2 ‎diabetes.‎AimsTo assess the cardiovascular safety and efficacy of semaglutide, a recently approved glucagon-like peptide 1 receptor agonist (GLP-1 RA) for type 2 diabetes.Methods Pub Med, ‎Google Scholar, and EBSCO ‎ databases were ‎systematically search for relevant articles. The terms‎ diabetes‎, Glucagon-like peptide, semaglutide‎ were used. Out of hundred twenty-two records, only ‎four fulfilled ‎the inclusion criteria.Results Four placebo-controlled studies with oral semaglutide ‎were included. Single study concern about the cardiovascular safety of oral semaglutide ‎and showed that, ‎compared with placebo, semaglutide ‎ was not associated ‎with increased in the cardiovascular events. On the other ‎hand, the remaining trials shown that, semaglutide ‎ can ‎effectively control the blood glucose as evident by ‎reduction in HA1c.ConclusionOral semaglutide can effectively and safely lower blood glucose without increase in the major adverse ‎cardiovascular events‎‎ (MACE).

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication